Decriminalising drug use could drastically reduce crime and improve health, the outgoing president of the Royal College of Physicians has said.Sir Ian Gilmore said the laws on misuse of drugs should be reviewed and that their supply should be regulated.

He had formed his view after seeing the problems caused by dirty needles and contaminated drugs, the BBC’s health correspondent Adam Brimelow said.

In a parting e-mail to 25,000 RCP members, which Sir Ian said expressed his own views rather than those of the RCP, he wrote that he felt like finishing his presidency on a “controversial note”.

He endorsed a recent article in the British Medical Journal by Stephen Rolles, from the think tank Transform Drug Policy Foundation, which argued that the policy of prohibition had harmed public health, encouraged organised crime and fuelled corruption.

Sir Ian told the BBC: “Everyone who has looked at this in a serious and sustained way concludes that the present policy of prohibition is not a success. There are really strong arguments to look again.”

Sir Ian said he had had a longstanding interest in the subject, stemming from his work as a liver specialist.

“Every day in our hospital wards we see drug addicts with infections from dirty needles, we see heroin addicts with complications from contaminated drugs,” he said.

He argued that many of the problems health staff encountered were the consequences not of heroin itself, but of prohibition.

In his e-mail, Sir Ian wrote: “I personally back the chairman of the UK Bar Council, Nicholas Green QC, when he calls for drug laws to be reconsidered with a view to decriminalising illicit drugs use. This could drastically reduce crime and improve health,” he wrote.
In his recent report to the Bar Council, Mr Green said there was growing evidence that decriminalising personal use could free up police resources, reduce crime and improve public health.

Mr Rolles – whose recent BMJ article Sir Ian cited in his e-mail – told BBC Radio 4’s Today programme their arguments were “built on a critique of the failure of the last 40 or 50 years”.

He said the “punitive criminal justice-driven war on drugs” had delivered the opposite of its goals.

“It hasn’t reduced drug use, it hasn’t prevented the availability of drugs, but it has created a whole raft of secondary problems associated with the illegal market, including making drugs more dangerous than they already are and undermining public health and fuelling crime.”

“That is provoking a debate on what the alternative approaches are and the one that we are calling for is legally regulated production supply.”

Health workers made more than 1,300 mistakes involving the use of strong painkilling drugs in less than a year, resulting in at least three deaths and severe harm to two other patients.Nearly one in five dosage errors involving morphine, diamorphine and similar opiate drugs resulted in some harm to NHS patients.

Figures released under a Guardian Freedom of Information request show mistakes in England and Wales continue at a high level despite the publicity that followed the Guardian’s revelation in May last year about the death of David Gray.

The 70-year-old died at his home in Cambridgeshire when he was injected with a tenfold overdose of diamorphine by Daniel Ubani, a locum GP who had flown in from Germany that day.

The official report into the incident last month revealed two other GPs hired, like Ubani, by Take Care Now – a now-defunct company that was then providing some out of hours services for the NHS – had been involved in non-fatal diamorphine overdoses the year before.

The breakdown of the new figures suggest lessons have not been learned, with little change in the numbers of people harmed by medication errors involving this class of drugs despite several official safety warnings.

David Gray’s son, Rory, called the new figures “unbelievable”. “Taken at face value [they] suggest nothing has been made safer with regards to opiate medicines at all. Whilst there is no accountability then it seems there will continue to be no effective measures put in place to stop these unnecessary and avoidable deaths.”
The charity Action against Medical Accidents (AvMA) said the statistics were shocking and “confirm our worst fears about not implementing patient safety alerts”.

In its own research, coincidentally being published at the same timetoday, the organisation accuses hospitals and other care providers of killing and injuring patients by not complying with official directives from the National Patient Safety Agency (NPSA) intended to protect those receiving care.

However, safety experts point out that the numbers of patients being treated by such drugs is rising, so the proportion of mistakes may be going down.

Both the NPSA, established in 2003 to help the NHS learn from its mistakes, and the Care Quality Commission (CQC), the health service regulator, insisted things were improving, although notifying the two bodies over drug and other errors that resulted in death or severe harm only became mandatory on 1 April this year.

The NPSA received a total of 4,223 cases involving opiate drugs between November 2004 and June 2008. Of these, 3,338 were recorded as causing no harm, 629 low harm, 242 moderate harm and four severe harm. Five patients died. There was insufficient data on five other cases. Figures from May 2009 to April this year show 1,329 cases, 1,078 said to have resulted in no harm, 179 low harm, 67 moderate, and two severe. Three patients died.

Linda Hutchinson, CQC director, said: “Unfortunately we will never be able to eliminate human error from healthcare, but the risks can be minimised. That is why it is so important that NHS trusts and other health providers report incidents, thoroughly investigate them and make changes to stop the same mistakes happening again. They should also implement changes as a result of safety alerts. Had Take Care Now done this, it is possible that Mr Gray would still be alive today.

“The increase in reporting is a good thing. We often find it is the NHS trusts reporting a high number of incidents that are doing a better job of investigating them and taking action to prevent them happening again.”

The NPSA said its reporting system was one of the most sophisticated in the world: “We gather patient safety incidents, analyse them for trends and use these as a platform on which to produce patient safety alerts and guidance for the NHS.

“It is evident the reporting culture in the NHS has improved with over 1 million incidents [relating to drugs, medical and surgical procedures] reported each year. The majority of incidents reported to us in relation to diamorphine and other opiates result in low or no harm to the patient. In addition, most of these do not relate to mis-selection of injectable diamorphine or morphine.”

The agency believed it was now told of the “vast majority” of serious incidents.

The revelations come as hospitals and other providers of care are accused by AvMA of killing and injuring patients by not complying with official directives from the NPSA intended to protect those receiving care. Dozens of hospitals, mental health trusts and primary care trusts are failing to implement patient safety alerts from the agency, despite the Department of Health writing to them reminding them to do so.

Some 29 NHS organisations had not put at least 10 alerts into action by 7 June, on issues such as drugs and oxygen, even though with some, the deadline for compliance was several years earlier, according to AvMA: “It is impossible not to conclude that lives are being put at unnecessary risk and it is likely that avoidable injuries or deaths are still being caused as a result of trusts not complying,” it says.

Public health minister Anne Milton said: “Across the NHS there must be a culture of patient safety above all else. We have set out how we intend to free NHS staff from central control and targets that are not clinically justified to allow them to focus on what really matters – reliable, effective and above all safe care for each patient.”

The NHS spends up to £86m a year on thousands of websites that are difficult to find, confusing for patients and which do not meet their needs, according to research commissioned for a Department of Health report.Research for the NHS Digital Communications Review, conducted by communications agency Precedent and leaked to the Health Service Journal, found 2,873 nhs.uk websites that were in use and more than 1,000 other nhs.uk sites that were no longer active. A total of 287,300 web pages were accessible and Google listed 56 million pages within the nhs.uk domain.

The researchers concluded that the public would appreciate fewer contact points online but the digital communications review said there was not sufficiently strong evidence that there were too many NHS domains.

Instead the review said there was a need for a digital brand strategy with standards for all NHS sites. It said a central information role was “sound in principle but its adoption requires a general acceptance that it is the role of the centre to perform this organising function.”

EHI understands that the researchers suggested that the NHS may be spending too little on too many websites rather than too much.

The Precedent researchers said that two of most recognised health service websites, NHS Choices and NHS Direct, were often competing for attention and although NHS Choices focuses on health information and local service data and NHS Direct offers online diagnostic tools the differences in content between the two was not clear to patients.

They added: “NHS Choices and NHS Direct are both established as national sites with similarities of positioning, brand and audience. This confuses users about the ‘definitive’ access point for NHS information and the roles of each site.”

Research for the review also concluded that GP practices websites were also the weakest of the health service’s online offerings.

It added: “GP surgeries have by far and away the poorest sites, in that they have the largest percentage of problems identified. GP sites failed to provide the means to allow interaction with users.”

The researchers found that overall the NHS was failing to meet patients’ needs for online functionality such as online appointment booking, repeat prescription requesting, test result reporting and contact via email. Only 50.3% of sites included email addresses. “The NHS is not making itself easy to do business with,” the report said.

The research is also critical of the accessibility of websites and said that vulnerable members of the public were not been catered for with 30% of sites exhibiting at least one “notable deficit in standards” which might cover poor quality content, lack of NHS branding, poor navigation or out of date content.

The researchers said it was very difficult to estimate the cost to the NHS of the websites with responses to information on usage and cost received from only 188 out of 4,121 sites. However it estimated that the cost of running the sites “could be as high as £86m per year” and said costs could be higher as those figures did not include set up costs.

The digital review, however, said no broad conclusions could be drawn about value for money “given the relatively low cost of establishing and operating small, focused websites.”

The researchers claimed the public “struggled to locate the NHS online with a Google search” when searching on health-related terms and said the scale and depth of information on offer was daunting to many. It said patients also often ended up going to information offered by Wikipaedia, the charity sector and websites such as NetDoctor and PatientUK rather than the NHS.

The researchers said interviews with users revealed that the public wanted to see “one NHS” online which would tally with their perception that they were receiving care from “one NHS”.

The Department of Health said the white paper had outlined the government’s plan to being about an NHS information revolution to give people access to comprehensive, trustworthy and easy to understand information. Information on how this will be achieved is to be set out in the DH’s information strategy, due to be published in the autumn.

Britain’s top GP has launched a scathing attack on widespread reckless public behaviour towards food, alcohol and cigarettes, which he claims is causing growing levels of disease and early death.In a dramatic intervention in the public health debate, Professor Steve Field criticises parents, mothers-to-be, the very overweight, smokers and drinkers for damaging their own health, or their children’s, through irresponsible actions.

Writing in the Observer, Field, chairman of the Royal College of General Practitioners, backs the controversial call by Andrew Lansley, the health secretary, for Britons to take more responsibility for protecting their health.

“The truth is that too many of us neglect our health, and this is leading to increasing levels of illness and early death,” Field writes. Soaring levels of diabetes, much of it caused by obesity, and the medical consequences of heavy drinking, which are affecting ever-younger people, illustrate this widespread failure, he adds.

Discussion of the harmful medical consequences of ill-advised personal behaviour is curtailed because of its sensitivity, Field argues.

“Too many people do not face up to the hard facts, as they perceive them to be an attack aimed, in particular, at the poorer members of society. But it is impossible to argue on medical or ethical grounds that such behaviour is acceptable.”

While arguing for health prevention to become an individual duty and start at home, Field makes it clear that he does not want people to be left to make lifestyle changes on their own or to see personal responsibility as a total solution. Those who seek to alter their behaviour need continuing NHS and government help, he adds.

“So please don’t take offence if we [GPs] tell you to lose weight or stop smoking or drinking. You need to face facts and take responsibility. Support is out there and it could save your life – and save the NHS a fortune.”

Anne Milton, the public health minister, said greater personal responsibility was vital. Many senior doctors also agreed, but stressed that government action was needed to help create a climate in which people could swap healthy for unhealthy behaviour, such as by monitoring big food companies.

Lansley has alarmed senior doctors by saying the coalition will use much less regulation than Labour did to tackle problems such as obesity and smoking.

GPs seek to help people live healthy lives “but every day we are confronted by the harm caused by smoking, excessive alcohol consumption and the ‘tsunami’ of obesity”, adds Field, the leader of the country’s 40,000 GPs.

Irresponsible parents are damaging their children’s health by smoking around them, feeding them unhealthy food and failing to act as good role models, he says. Mothers and fathers who smoke in cars carrying their offspring – who Field says “are committing a form of child abuse” – and at home in front of their children kill more young people than do accidental injuries.

Parents who give their children unhealthy food, or serve them large portions are storing up huge problems for them, says Field. “Unless parents exert more control over their children’s diets, they are risking a lifetime of health problems, and even premature death – death before their parents, which is almost too sad to contemplate,” he adds.

Parents’ failure to safeguard their children from sunburn and using sunbeds can also lead to them developing skin cancer, he argues. Mothers who smoke while pregnant risk causing their child’s death through cot death syndrome, asthma, lung infections or house fires. Would-be mothers and women who are already expecting need to control their weight because maternal obesity can harm the mother or her baby.

Instead of becoming obese and then asking the NHS to provide liposuction or gastric bands, “it would be better if people didn’t become fat in the first place”, by eating better and exercising more.

Agreeing with Field, Milton said: “We need a new public health movement, owned by everyone, for everyone’s benefit. A movement that transforms the way in which the public’s health is improved, but also revolutionises the way we think about it. As Field points out, personal responsibility is a key part of this.”

However, Milton added: “The government recognises that it cannot force people into behaving in a certain way. But we can help people make informed decisions and ensure that they are enabled and supported to make healthy choices.”

Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, agreed some parents let down their children. “Of course paediatricians agree that people should take responsibility for their own lives. But young children cannot do that. What they eat and the environment they live in are determined by their parents. There is a role for society to protect young children from promotion of unhealthy foods and passive smoking. Would all parents strap young children into a car seat if it was left to choice rather than law?”

He urged a twin-track approach of exhorting parents to care for children well but society also intervening to help by, for example, limiting advertising of unhealthy foods.

Dr John Middleton, vice-president of the UK Faculty of Public Health, said: “A significant amount of ill-health is due to people’s lack of personal responsibility. The NHS would have fewer burdens on it if people were more physically active, cut their alcohol consumption and ate a lower-fat, lower-sugar diet. The government and the NHS cannot do everything. But someone trying to give up smoking will find it easier if they get counselling and nicotine replacement therapy on the NHS, for instance.”

The government had a key role to play in promoting health, as shown by its crackdown on smoking and its fluoridisation of water supplies, said Professor Dinesh Bhugra, president of the Royal College of Psychiatrists. People who insisted on smoking despite all the warnings about it should retain their freedom to do so, he added.

But Tam Fry, National Obesity Forum spokesman, suggested Field was being naïve. “If Professor Field wants a world where everyone assumes personal responsibility, he is living a dream. He appears to have forgotten the 35-40% of our population who live in the same obesogenic environment as he does but simply can’t cope with it or have long since given up the unequal struggle. They are the people who are quite unequipped to resist the 24/24 battering of junk food promotion and are easy prey for the marketing men.”

However, “certainly the 40% of women entering pregnancy either overweight or obese do so simply because they have never had role model lessons in parenting from either their own mothers or health professionals”, Fry added.

An investigation found that 320 hospital, ambulance and health authority chiefs are paid more than David Cameron’s annual salary of £142,500.The report comes as the health service faces cuts to frontline services to reduce the deficit. Of those 58 are paid more than £200,000 a year. Financial experts described the salaries as “unsustainable”.

The number of high-earners has increased 50-fold since Labour came to power in 1997. Prior to that only six NHS officials were paid more than John Major, who then earned a salary of £101,557.

The highest paid was Ian Miller, Interim Director of Finance and Investment for South East Coast Strategic Health Authority, who earned £310,000 for nine months work from April 2009 to January 2010.

His salary – which would be £400,000 per year – would pay for up to 14 nurses.

In total 734 staff earned more than £100,000 per year according to available records.

Matthew Elliott, chief executive of the TaxPayers Alliance, said: “It’s shocking that pay in some parts of the NHS has now reached these stratospheric new heights. It simply isn’t sustainable.”

Anthony Marsh, chief executive of West Midlands Ambulance Service NHS Trust, earns £232,000 – more than 14 times the salary of some ambulance drivers.

Pay does not appear to be linked to performance. Martin Yeates, former chief of Mid Staffordshire NHS Trusts, which runs Stafford hospital where 400 died due to inadequate care, earned up to £160,000 a year before he left.

Meanwhile the Department of Health said it was “committed to cutting NHS management costs” and planned to reduce them by 46 per cent in the next three to four years.

Ministers are considering ‘privatising’ an NHS agency that provides 50,000 nurses and other workers to the health service.An advert has been placed for private sector investment in NHS Professionals, a company owned by the Department of Health, which provides bank staff to fill shifts in the health service.

Unions criticised the plan saying it was privatisation and that NHS Professionals was set up to stop the NHS being ripped off by private agencies charging large sums for staff to work unfilled shifts.

NHS Professionals has 50,000 staff on its books who cover around two million shifts in 77 organisations around England.

Karen Jennings, head of health at Unison, said: “The whole reason that NHS Professionals was set up, was because private agencies were ripping off hospitals by charging them outrageous fees for recruiting or finding staff for shifts. It makes no sense at all to bring back private companies who will want their slice of the action in return.

“This proposal is purely about Tory plans to promote privatisation and hive off parts of the NHS to private companies, regardless of the consequences on patient care.”

A Department of Health spokesman said: “This is about exploring ways that the commercial skills of the independent sector can make NHS Professionals Ltd a more efficient business and save the NHS money.

“NHS Professionals Ltd is a business, not a public service, and like any business it must ensure its services are as efficient and effective as possible. We want to discuss options with potential independent sector investors that could help to achieve this, and ultimately improve services outcomes for patients.”

It comes as the Royal Berkshire Hospital Trust announced up to 600 jobs will be cut to make £60 million worth of savings in the next few years, pledging that frontline staff would not be affected.

The Royal College of Nursing said last month that thousands of NHS jobs were being cut despite Government promises to protect frontline services.

The nurses’ group said it was aware of almost 10,000 posts lost through recruitment freezes, redundancies and people not replaced when they retired, or which face cuts in the future.

The declining role of GPs in maternity care is leading to some pregnant women feeling “abandoned” by the system, a leading think-tank has claimed.Often expectant mothers do not know who to turn to if they suffer health problems during pregnancy, according to The King’s Fund.

Although family doctors frequently know a woman’s medical history best, their role in pregnancy care has become sidelined in recent decades, found the authors of the report, The role of GPs in maternity care – what does the future hold?

The King’s Fund concluded that GPs’ role in maternity care had “all but disappeared over the past 30 years, with recent policy and guidance omitting any reference to their role in caring for pregnant women”.

“Under the terms of the new GP contract introduced in 2004, GPs are no longer paid for each pregnant woman they look after,” it noted.

“In addition, many GPs have opted out of providing out-of-hours care, resulting in sick pregnant women going to A&E with pregnancy-related problems – or simply not knowing what to do if they are ill.”

Nick Goodwin, director of the Fund’s GP Inquiry, said such care was increasingly dealt with by specialists, which had led to a less connected service for pregnant women.

He said: “As a result of that you get reports that some mothers feel a bit abandoned at the beginning of their pregnancy. Who is looking after them?”

Sometimes pregnant women’s other health needs – like mental health issues and obesity – were not being dealt with, he said.

“More needs to be done to make sure that the whole person is treated.”

The report proposed that GPs should now take “a more active role”.

Anna Dixon, lead author of the report and director of policy at The King’s Fund, said: “It is right that those with specialist skills, such as midwives and obstetricians, take the lead role in caring for pregnant women but GPs have a vital role to play in pre-conception and shared ante-natal and post-natal care.”

The report has been widely welcomed by GPs’ groups.

Dr Laurence Buckman, chairman of the BMA’s GPs Committee, said: “GPs want to be more involved in maternity care because they see it as an important part of their job.”

Prof Steve Field, chairman of the Royal College of General Practitioners, welcomed the “timely” report, saying it made “a very compelling case for GPs to play a more central role”.

However, Belinda Phipps chairman of the National Childbirth Trust, which campaigns for less medical intervention during pregnancy and birth, said it would be better to “actively promote midwife-led care to women”.

McDonald’s, Burger King and other fast food outlets should offer diners free drugs to compensate for the risk of heart disease, cardiologists have proposed.If burger joints offered cholesterol-lowering statins, customers would offset the unhealthy effects of a cheeseburger and milkshake, according to researchers at Imperial College London.

The pills could be placed beside the salt, pepper and tomato ketchup to encourage people to pop one after their meal.

The suggestion is made in a paper by Dr Darrel Francis, a cardiologist at Imperial’s National Heart and Lung Institute, and colleagues published in the American Journal of Cardiology.

The idea was criticised by leading doctors, who said the study could encourage ill-health by prompting even greater consumption of junk food and increasing the belief in “a pill for every ill”.

Francis said: “Statins do not cut out all of the unhealthy effects of burgers and fries. It’s better to avoid fatty food altogether. But in terms of your likelihood of having a heart attack, taking a statin can reduce your risk to more or less the same degree as a fast food meal increases it.”

People eat fast food despite knowing that it is bad for them. Given that, said Francis: “It makes sense to make risk-reducing supplements available just as easily as the unhealthy condiments that are provided free of charge. It would cost less then 5p per customer – not much different to a sachet of ketchup.”

The proposal was in line with other established risk-reducing measures such as wearing a seatbelt or buying filtered cigarettes, Francis argued.

Professor Steve Field, chairman of the Royal College of General Practitioners, denounced the proposal. “This paper just amazes me,” he said. “Let’s get real; we should be encouraging healthy lifestyles, not pill popping. This is an unwelcome addition to the ‘pill for every ill’ attitude that’s already much too common. The danger of this research is that some people will become even more complacent about eating fatty food and high calorie food, and might even increase their intake of them.”

While statins were generally safe they could increase the risk of muscle weakness and, in rare cases, of kidney failure, cataracts and liver problems, Field added.

Millions of Britons who have dangerously high cholesterol levels, and those with existing heart problems, take statins regularly to reduce the risk of a heart attack or stroke.

Professor Peter Weissberg, medical director of the British Heart Foundation, said: “The suggestion that the harmful effects of a junk food meal might be erased by taking a cholesterol-lowering statin tablet should not be taken literally. Statins are a vital medicine for people with, or at high risk of developing, heart disease. They are not a magic bullet.”

Tens of thousands of hospital patients were forced to be in mixed sex wards last year despite Labour promises that men and women would be separated, new figures suggest.The announcement came as the new coalition government revealed that men and women will no longer have to share facilities in English hospitals.

More than eight thousand breaches of Labour’s pledge to “virtually eliminate” mixed wards were reported in just half of England’s Strategic Health Authorities in the first quarter of this year, new figures show.

If the same level existed across the rest of the country it would mean there were more than 16,000 breaches in three months, equating to 64,000 cases a year.

Andrew Lansley, the Health Secretary, announced yesterday that the “indignity” of men and women sharing accommodation would be abolished, almost 15 years after Tony Blair made the same promise.

But men and women may still have to share wards, provided the hospital ensures that male and female patients sleep in separate areas and have their own washing facilities.

Labour committed in two manifestos to provide separate accommodation for men and women, except where it was in the interests of the patient not to do so.

They later decided to divide wards into same-sex “bays”, meaning same-sex accommodation could include men and women sleeping in separate partitions of the same ward.

But the new figures reveal that one in ten patients is still admitted to a mixed ward, while a third have to share bathrooms with members of the opposite sex.

The information suggests data is not being recorded consistently across the country and NHS organisations are continuing to place patients in mixed sex accommodation for “operational reasons”, the government claimed.

Under new steps announced by Mr Lansley, NHS organisations can be held accountable for failing to guarantee same-sex accommodation where there is no clinical justification.

From next January, any breaches of the guarantee will be reported regularly and commissioners will sanction NHS bodies which admit failing to meet the pledge.

For the first time the reports will be made publicly available, meaning patients receiving elective treatment can choose to avoid the worst-performing hospitals.

Mr Lansley told BBC Radio 4’s PM programme: “It should be more than an expectation, it should be a requirement that patients who are admitted should be admitted to single-sex accommodation.

“Patients should be in single-sex accommodation, meaning that all of their period that they are admitted they should be in a bed or a bay which only consists of people of the same sex.

“And they should be able to come and go, for example to all their washing and toilet facilities, without having to pass through a part of the ward or another ward where there might be people of a different sex… so to that extent they would have the kind of privacy and dignity people have a right to expect.”

He added: “Patients should not suffer the indignity of being cared for in mixed sex accommodation. I am determined to put an end to this practice, where it is not clinically justified.

“In the future, NHS organisations will have clear standards, spelling out when they should report a breach. Where NHS organisations fail to meet this standard, we will let the public know they have failed and we will strengthen the fines which may apply.”

Chief Nursing Officer Christine Beasley added: “Protecting the privacy and dignity of patients by eliminating mixed sex accommodation must be a priority for the NHS.

“Driving this change will be the publishing of statistics on mixed sex accommodation breaches by NHS trusts. This measure will allow patients to make better informed decisions about their care.”

The NHS in England faces a total bill of £65bn for new hospitals built under the private finance initiative (PFI)- six times more than the buildings cost.Figures obtained by the BBC show that some NHS trusts are spending more than 10 percent of their turnover on the annual ”mortgage” repayments.

Under PFI, private companies win contracts to build and maintain new hospitals and mental health units and the NHS pays off the ”mortgage” over around 30 years.

The 103 schemes were valued at a total of £11.3bn when they were built.

But when rising fees and additional costs such as maintenance, cleaning and catering are taken into account, the NHS will have to pay back £65.1bn over the lifetime of the schemes. Some contracts are reportedly so restrictive that trusts are forced to pay hundreds of pounds just to get half a dozen pictures put up.

According to the data, the NHS currently pays back a total of £1.25bn each year but this figure is expected to increase until 2030 when it will hit £2.3bn, the BBC reported.

The final payment will not be made until 2048.

Professor John Appleby, chief economist at the King’s Fund health think-tank, said: ”It is a bit like taking out a pretty big mortgage in the expectation your income is going to rise, but the NHS is facing a period where that is not going to happen.”

Dr Mark Porter, of the British Medical Association, added: ”Locking the NHS into long-term contracts with the private sector has made entire local health economies more vulnerable to changing conditions.

”Now the financial crisis has changed conditions beyond recognition, so trusts tied into PFI deals have even less freedom to make business decisions that protect services, making cuts and closures more likely.”

Nigel Edwards, director of policy at the NHS Confederation, which represents trusts, told the BBC: ”They were planned for a different world. I’m sure that in some cases people feel their hands are tied.”